Dual Acting Prodrugs

ABSTRACT

The present invention relates to a prodrug which comprises at least two different pharmaceutically and/or diagnostically active compounds independently bound by cleavable linkers and a protein-binding moiety which is capable of binding to carrier a molecule.

The present invention relates to a prodrug which comprises at least twodifferent pharmaceutically and/or diagnostically active compoundsindependently bound by cleavable linkers and a protein-binding moietywhich is capable of binding to carrier a molecule.

Most of the drugs used at present are compounds having low molecularweights and exhibit, when systemically administered to a patient, a highplasma clearance or total body clearance. Furthermore, said lowmolecular weight compounds show a high tendency to penetrate bodytissues by diffusion, resulting in a uniform bio-distribution. These arethe two main reasons why only small quantities of the drug reach thesite of action and, due to distribution over healthy tissues of thebody, said drugs give rise to problematic side-effects. Thesedisadvantages are of particular concern for those drugs having a highcytotoxic potential, such as cytotoxic agents, immunosuppressive agentsor virostatic agents.

Several strategies have been pursued for improving the selectivity oflow molecular weight drugs and thus to increase the concentration of theactive agent in the desired tissue, while the concentration of the sameis decreased in healthy tissues in order to reduce side-effects.

Carriers, such as for example albumin, or its drug conjugates exhibit amarkedly long half-life in the systemic circulation of up to 19 days(cf. Peters, T. J., “Serum Albumin”, Adv. Protein. Chem., 1985, 37,161-245). Because of an elevated permeability of vessel walls of thee.g. malignant, infected or inflamed tissue for macromolecules, thecarrier, such as for example serum albumin, passes preferentially intothe target tissue (cf. Maeda, H., Mastumura, Y., Crit. Rev. Ther. DrugCarrier Sys., 1989, 6, 193-210). In this context, prodrugs have beenpresented which bind in situ to e.g. human serum albumin and showimproved properties in contrast to the drug alone (cf. DE 103 10 082 A1and DE 10 2005 009 084 A1).

In addition, antibodies, peptides or synthetic polymers have beeninvestigated as drug carriers for the development of prodrugs (Kratz etal., (2001): Anticancer drug conjugates with macromolecular carriers, inPolymeric Biomaterials, second edition, ed. S. Dumitriu, Marcel Dekker,New York, Chapter 32, 851-894; R. Duncan, Nat. Rev. Drug Discovery 2003,347-360).

However, although such prodrugs have been shown to allow a more specificdelivering of the active agent to the target tissue in most cases, avariety of biochemical mechanisms is known which lead to a decreasedefficacy of the respective drug.

For example, intrinsic or acquired multidrug resistance (MDR) is a majorproblem in the treatment of many cancers. A number of biochemicalmechanisms have been described that are responsible for the multidrugresistance phenotype that include changes in the cellular target of therespective drug, alterations in enzymatic activation, detoxificationmechanisms or cell cycle checkpoints, defective apoptotic pathways orinsensitivity to apoptosis, membrane changes as well as elimination ofthe drug from the tumor cell through the action of drug efflux pumps.Many studies have evaluated the cellular resistance mechanisms, e.g. inbreast cancer, that are mediated by the cell-membrane efflux pumpsP-Glycoprotein, Multiple Resistance Protein (MRP) and Breast CancerResistance Protein (BCRP) which belong to the ATP-binding cassette (ABC)transporter family (Ling et al., Cancer Chemother. Pharmacol., 1997, 40:3-8; Borst et al., Biochim. Biophys. Acta, 1999, 1461:347-357; Thomasand Coley, Cancer Control, 2003, 10:159-165, Wang, J. Clin. Pharm.Ther., 2003, 28:203-228; Leonessa and Clark, Endocrine-Related Cancer,2003, 10(1):43-73).

Another example relates to the transcription factor NF-κB which plays akey role in the development and progression of tumors, since it controlsseveral signalling pathways in apoptotic, cell cycle and cell migrationprocesses. The overexpression of NF-κB which is triggered inherently orin the presence of cytostatic agents prevents apoptosis in tumor cellsand is thus responsible for the development of chemoresistance.

Therefore, a need exists for improved drugs which enable the treatmentand/or diagnosis of a disease in a patient, and which avoid or at leastreduce the above-described disadvantages.

In view of the above, the technical problem underlying the presentinvention is to provide novel prodrugs which should act by a dual actingprinciple through additive or synergistic effects, e.g. by modulatingcellular functions or chemosensitizing, thus improving the effect of therespective drugs.

According to the present invention, the above problem is solved byproviding a dual acting prodrug comprising

(i) at least a first pharmaceutically and/or diagnostically activecompound,

(ii) at least a second pharmaceutically and/or diagnostically activecompound,

(iii) two or more cleavable linkers, and

(iv) a protein-binding moiety,

wherein the first and the second pharmaceutically and/or diagnosticallyactive compounds are each bound to a cleavable linker, andwherein the first and the second pharmaceutically and/or diagnosticallyactive compounds are different from each other.

According to the present invention, there is no specific restriction asto how the components, i.e. the pharmaceutically and/or diagnosticallyactive compounds, the cleavable linkers and the protein-binding moiety,of the above-defined prodrug are connected to each other, as long aseach of the pharmaceutically and/or diagnostically active compound isbound to a cleavable linker and the biological function of theprotein-binding moiety and the pharmaceutically and/or diagnosticallyactive agents are not negatively affected by the structure set up. Themolecular structure of the prodrug of the present invention may forexample have a linear form or a branched form or is present in acircular form.

According to the present invention, there is no specific restrictionconcerning the structural setup of the prodrug of the present invention;i.e. the way the constituents as outlined under above items (i) to (iv)of the above-defined prodrug are chemically bonded together. Inparticular, the prodrug according to the present invention may containone or more spacers in any position between the constituents of theabove-defined prodrug, i.e. the protein-binding moiety may for examplebe bound to the rest of the prodrug through a spacer or, as anotherexample, the first pharmaceutically and/or diagnostically activecompound may be bound to the at least one cleavable linker through aspacer. Furthermore, the function of e.g. the cleavable linker may beincorporated in such a spacer, i.e. a spacer may be used between thepharmaceutical and/or diagnostically active compound which can alsoserve as the cleavable linker. It is also possible to bind thepharmaceutically and/or diagnostically active compound, the cleavablelinker, and/or the protein-binding moiety to a central group, which maybe linear or branched, such as a peptide, a sugar, a heterocyclic group,or any inorganic or organic compound suitable to bind one or more of theconstituents of the prodrug.

The term “prodrug” as used herein means any form of a drug which isadministered to an organism, such as a human, in an inactive or lessactive form and is converted, e.g. by metabolization, into the activeform. Said conversion of the prodrug into the active form is notspecifically restricted and includes any chemical and/or physicalalteration of the prodrug which occurs after administration, such as forexample release of an active part of the prodrug at the site of action.

The expression “pharmaceutically active compound” means any compoundwhich brings about a pharmacological effect either by itself or afterits conversion in the organism in question, and thus also includes thederivatives from these conversions. The pharmacological effect of thepharmaceutically active compound according of the present invention canbe a single effect only, e.g. a cytostatic effect, or a broadpharmacological spectrum of action, such as an immunsuppressive andantiphlogistic effect at the same time.

The expression “diagnostically active compound” used herein is notspecifically restricted and includes any compound which can be detectedand preferably quantified, in an organism or parts thereof, such as forexample cells and/or fluids, such as for example the serum, throughsuitable chemical and/or physical measurement methods.

The expression “cleavable linker” means any linker which can be cleavedphysically or chemically. Examples for physical cleavage may be cleavageby light, radioactive emission or heat, while examples for chemicalcleavage include cleavage by redox-reactions, hydrolysis, pH-dependentcleavage or cleavage by enzymes.

According to a preferred embodiment of the present invention, thecleavable linker comprises one or more hydrolytically cleavable bonds,the hydrolysis of which releases the pharmaceutically and/ordiagnostically active compounds. Examples for hydrolytically cleavablebonds are ester bonds or metal-complex bonds, such as are present inplatinum-dicarboxylate complexes, where a diaminediaquoplatinum(II)complex is liberated.

In another preferred embodiment of the present invention, the cleavablelinker may be cleavable by an enzyme. For example, the cleavable linkerof the present invention may contain at least one peptide bond whichpreferably lies within a cleavable peptide sequence of a protease. Apeptide bond can therefore be implemented by the insertion of arespective peptide sequence into the cleavable linker. Suitable enzymesare, for example, proteases and peptidases, e,g. matrix metalloproteases(MMP), cysteine proteases, serine proteases and plasmin activators,which are formed or activated in intensified manner in diseases such asrheumatoid arthritis or cancer, leading to excessive tissue degradation,inflammations and metastasis. Preferred examples of proteases accordingto the present invention are in particular MMP-2, MMP-3 and MMP-9,cathepsin B, H, L and D, plasmin, urokinase, and prostate-specificantigen (PSA). Preferred peptide sequences that are incorporated in theprodrug are: Arg, Arg-Arg, Phe-Arg, Phe-Cit, Ile-Pro Lys, Lys-Lys,Arg-Lys, Ala-Leu-Ala-Leu, Phe-Lys, Phe-Lys-Ala, Val-Cit, Val-Arg,Ala-Phe-Lys, D-Ala-Phe-Lys, Met, Met-Met, Phe-Met, Tyr-Met, Ala-Met,Ala-Phe-Met, Phe-Ala-Met, Ala-Tyr-Met, Phe-Tyr-Met,Ser-Ser-Tyr-Tyr-Ser-Arg, Phe-Pro-Lys-Phe-Phe-Ser-Arg-Gln,Lys-Pro-Ile-Glu-Phe-Nph-Arg-Leu, Gly-Pro-Leu-Gly-Ile-Ala-Gly-Gln,Gly-Pro-Leu-Gly-Ile-Ala-Gly-Gln,Gly-Pro-Gln-Gly-Ile-Trp-Gly-Phe-Leu-Gly. In addition, the enzymaticallycleavable linker may contain a self-immolative linker such as aself-immolative p-aminobenzyloxycarbonyl (PABC) linker or a N-methyl- orsymmetric N,N-dimethylethylene linker.

In another embodiment of the present invention, the cleavable linkeraccording to the present invention preferably contains at least oneacid-labile bond. Examples of acid-labile bonds are ester, acetal,ketal, imine, hydrazone, carboxylhydrazone and sulfonylhydrazone bondsand bonds containing a trityl group.

According to the present invention, in case the pharmaceutically and/ordiagnostically active compound is a diagnostically active agent whichdoes not need to be cleaved, the cleavable linker may be chosen tocomprise only such bonds which are difficult to cleave underphysiological conditions such as an amide bond, carbon-carbon bonds orbonds between carbon and a heretoratom, wherein the heteroatom may beselected from O, N, S or P.

The term “protein-binding moiety” used herein is not specificallyrestricted and means any functional group which is capable of binding toan amino, a hydroxy or thiol group of a compound which may be ofendogenous or exogenous origin. Preferred examples of a protein-bindingmoiety according to the present invention are a maleinimide group, ahalogenacetamide group, a halogenacetate group, a pyridylthio group, avinylcarbonyl group, an aziridin group, a disulfide group, a substitutedor unsubstituted acetylene group, a hydroxysuccinimide ester group. Theprotein-binding group also includes functional groups, such as —COOH orSO₃H, that can be activated by standard coupling agents, e.g.dicyclocarbodiimides, acid chlorides, or peptide coupling reagents(e.g., BOP, HATU, PyBOP).

One or several prodrugs can be bound to any suitable carrier such aspeptides, sugars, serum proteins, antibodies or antibody fragments,growth factors, polysaccharides, or synthetic polymers. The carrier ingeneral contains suitable functional groups such as hydroxy, amino orthiol groups to bind the protein-binding prodrug. If necessary, thesecan be introduced in the carrier molecule by chemical modificationthrough techniques known to those skilled in the art (Kratz et al.,(2001): Anticancer drug conjugates with macromolecular carriers, inPolymeric Biomaterials, second edition, ed. S. Dumitriu, Marcel Dekker,New York, Chapter 32, 851-894).

In a preferred embodiment, the protein-binding moiety of the prodrugaccording to the present invention allows said prodrug to bind in situafter administration by e.g. injection, to components of body fluidsand/or tissue components, preferably to serum proteins and morepreferably to serum albumin, particularly to cysteine-34 of serumalbumin and are then present as macromolecular prodrugs which carry thepharmaceutically and/or diagnostically active compounds to the targetsite.

In a further preferred embodiment, the protein-binding moiety of theabove-defined prodrug binds in situ to cysteine-34 of albumin.

According to the present invention, the term “in situ” includes thebinding of the prodrug according to the present invention to anendogenous biomolecule, such as a serum protein, particularly serumalbumin, inside the organism to which the prodrug has been administered.

According to one embodiment of the present invention, in the prodrug asdefined above the first and second pharmaceutically and/ordiagnostically active compounds are independently selected from thegroup consisting of a cytostatic agent, a cytokine, animmunosuppressant, an antirheumatic, an antiphlogistic, an antibiotic,an analgesic, a virostatic, or an antimycotic agent, a transcriptionfactor inhibitor, a cell cycle modulator, a MDR modulator, a proteasomeor protease inhibitor, an apoptosis modulator, an enzyme inhibitor, anangiogenesis inhibitor, a hormone or hormone derivative, a radioactivesubstance, a light emitting substance, or a light absorbing substance.

Especially suitable cytostatic agents according to the present inventionare the N-nitrosoureas such as nimustine, the anthracyclinesdoxorubicin, daunorubicin, epirubicin, idarubicin, mitoxantrone andametantrone, and any derivatives thereof; the alkylating agentschlorambucil, bendamustine, melphalan, and oxazaphosphorines, and anyderivatives thereof; the antimetabolites, for example purine antagonistsor pyrimidin antagonists, such as 5-fluorouracil,2′-deoxy-5-fluorouridine, cytarabine, cladribine, fludarabine,pentostatine, gemcitabine and thioguanine, and any derivatives thereof;folic acid antagonists such as methotrexate, or raltitrexed, pemetrexedor plevitrexed, the taxanes paclitaxel and docetaxel, and anyderivatives thereof; the camptothecins topotecan, irinotecan,9-aminocamptothecin and camptothecin, and any derivatives thereof; theVinca alkaloids vinblastine, vincristine, vindesine and vinorelbine, andany derivatives thereof; calicheamicins; maytansinoids; auristatins,epothilones, bleomycin, dactinomycin, plicamycin, mitomycin C andcis-configured platinum(II) complexes.

Especially suitable cytokines according to the present invention are,for example, interleukin 2, interferon α-2a, interferon α-2b, interferonβ-1a, interferon β-1b, interferon γ-1b, tumor necrosis factor, and anyderivatives thereof.

Especially suitable immunosuppressants according to the presentinvention are, for example, cyclosporin A, tacrolimus, sirolimus,everolimus, mycophenolatmofetil, and any derivatives thereof.

Especially suitable antirheumatics according to the present inventionare, for example, methotrexate, leflunomid, sulfasalazine, chloroquine,and any derivatives thereof.

Especially suitable antiphlogistics and/or analgesics according to thepresent invention are, for example, salicylic acid derivatives such asfor example acetylsalicylic acid, and any derivatives thereof; drugderivatives having an acetic or propionic acid group such as diclofenacor, respectively, naproxen, and aminophenol derivatives such as forexample paracetamol.

Especially preferred antibiotics according to the present invention are,for example, sulfanilamide, sulfacarbamide and sulfamethoxydiazine, andany derivatives thereof; penicillins, for example 6-aminopenicillanicacid, penicillin G as well as penicillin V, and any derivatives thereof;isoxazolylpenicillins such as oxacillin, cloxacillin and clucloxacillin,and any derivatives thereof; α-substituted benzylpenicillins such asampicillin, carbenicillin, pivampicillin, amoxicillin, and anyderivatives thereof; acylaminopenicillins, for example mezlocillin,aziocillin, piperacillin, apalcillin, and any derivatives thereof;amidinopenicillins, for example mecillinam; atypical β-lactams such asimipenam and aztreonam; cephalosporins, for example cephalexin,cefradin, cefaclor, cefadroxil, cefixime, cefpodoxime, cefazolin,cefazedone, cefuroxime, cefamandole, cefotiam, cefoxitin, cefotetan,cefmetazole, latamoxef, cefotaxmine, ceftriaxone, ceftizoxime,cefmonoxime, ceftazidime, cefsulodin and cefoperazone, and anyderivatives thereof; tetracyclines such as tetracycline,chlorotetracycline, oxytetracycline, demeclocycline, rolitetracycline,doxycycline, minocycline, and any derivatives thereof; chloramphenicolssuch as chloramphenicol and thiamphenicol, and any derivatives thereof;gyrase inhibitors, for example nalidixic acid, pipemidic acid,norfloxacin, ofloxacin, ciprofloxacin and enoxacin, and any derivativesthereof; and antituberculotics such as isoniazid, and any derivativesthereof.

Especially preferred virostatics according to the present invention are,for example nucleoside analogs such as acyclovir, ganciclovir,idoxuridine, ribavirin, vidaribine, zidovudine, didanosine and2′,3′-dideoxycytidine (ddC), and any derivatives thereof, as well asamantadine.

Especially suitable antimycotic agents according to the presentinvention are, for example, amphotericin B, and any derivatives thereof.

Especially preferred MDR modulators according to the present inventionare verapamil, dihydropyridins, cyclosporin A and D, tacrolismus,rapamyin, digoxin, digitoxin, quinidin, lovastatin, atorvastin,analogues of reserpine, trifluoroperazine, pervilleines A-F, valspodar,dexverapamil, biricodar, bepridil, erythromycin, levofloxacin, losartan,morphin, rifampin, phenytoin, colchicin, rhodamin 123, amprenavir,indinavir, nelfinavir, saqunavir, ritonavir XR9576, LY335979, OC144093,R101933, GF120918, ONT-093, MS-209, S-9788, reversin 205 and 121, or anyrelated derivative.

Especially preferred transcription factor inhibitors according to thepresent invention are, for example compounds that inhibit activation ofNF-κB such as alpha-lipoic acid, alpha-tocopherol, anetholdithiolthione(ADT), butylated hydroxyanisole (BHA), cepharanthine, caffeic acidphenethyl ester (3,4-dihydroxycinnamic acid, CAPE), catecholderivatives, diethyldithiocarbamate (DDC), diferoxamine, dihydrolipoicacid, disulfram, dimethyldithiocarbamates (DMDTC), curcumin(diferuloylmethane), EPC-K1 (phosphodiester compound of vitamin E andvitamin C), epigallocatechin-3-gallate (EGCG; green tea polyphenols),ethylene glycol tetraacetic acid (EGTA), glutathione, L-cysteine,lacidipine, melatonin, N-acetyl-L-cysteine (NAC), nordihydroguaiariticacid (NDGA), phenanthrolines, pyrrolinedithiocarbamate (PDTC),quercetin, tepoxaline(5-(4-chlorophenyl)-N-hydroxy-(4-methoxyphenyl)-N-methyl-1H-pyrazole-3-propan-amide),vitamin C, vitamin E derivatives, alpha-torphryl succinate,alpha-torphryl acetate, PMC (2,2,5,7,8-pentamethyl-6-hydroxychromane),benzyisocyanate, resveratol, genistein, lupeol, lycopene, panepoxydone,epoxyquinomicin C, dehydroxymethylepoxyquinomicin (DHMEQ),cycloepoxydon, gliotoxin, as well as I-κB-alpha phosphorylation and/ordegradation inhibitors such as PS-1, 145, aspirin, salicylic acid,BAY-11-7082 (E3[(4-methylphenyl)-sulfonyl]-2-propenenitrile),BAY-11-7085 (E3[(4-t-butylphenyl)-sulfonyl]-2-propenenitrile),cycloepoxydon; 1-hydroxy-2-hydroxymethyl-3-pent-1-enylbenzene,ibuprofen, prostaglandin A1, sanguinarine (pseudochelerythrine,13-methyl-[1,3]-benzodioxolo-[5,6-c]-1,3-dioxolo-4,5 phenanthridinium),sulfasalazine, sulindac, capsaicin (8-methyl-N-vanillyl-6-nonenamide),emodin (3-methyl-1,6,8-trihydroxyanthraquinone), erbstatin (tyrosinekinase inhibitor), estrogen (E2), gliotoxin, genistein, resiniferatoxin,and miscellaneous inhibitors of NF-κB such as beta-amyloid protein,glucocorticoids (dexamethasone, prednisone, methylprednisolone),leptomycin B (LMB), o,o′-bismyristoyl thiamine disulfide (BMT), ADPribosylation inhibitors e.g., nicotinamide, 3-aminobenzamide, bi-, tri,or tetracyclic lactames, 1,8-naphtalimide derivatives,phenanthridin-6-ones, 3,4-dihydro-5-methyl-isoquinolin-1(2H)-one,benzoxazole-4-carboxamide, 1,6-naphthyridine-5(6H)-ones,quinazolin[3,4-d]pyrimidin-4(3H)-ones, 1,5-dihydroxyisoquinoline,2-methyl-quinazolin-4[3H]-ones, 1,11b-dihydro-[2H]benzopyrano[4,3,2-de]isoquinolin-3-one, atrial natriuretic peptide (ANP),atrovastatin (HMG-CoA reductase inhibitor), calcitriol(1a,25-dihydroxyvitamine D3), E3330 (quinone derivative), herbimycin A,hypericin, hydroquinone (HQ), KT-90 (morphine synthetic derivatives),mevinolin, 5′-methylthioadenosine (MTA), pentoxifylline (1-(5′-oxohexyl)3,7-dimethylxanthine, PTX), phenyl-N-tert-butylnitrone (PBN), pituitaryadenylate cyclase-activating polypeptide (PACAP), quinadril (ACEinhibitor), ribavirin, secretory leukocyte protease inhibitor (SLPI),serotonin derivative (N-(p-coumaroyl) serotonin,), silymarin, vasoactiveintestinal peptide (VIP), D609 (phosphatidylcholine-phospholipase Cinhibitor), RO31-8220 (PKC inhibitor), SB203580 (p38 MAPK inhibitor),triptolide (PG490, extract of Chinese herb), LY294,002, mesalamine,wortmannin (fungal metabolite), or CHS 828(N-(6-(p-chlorophenoxy)-hexyl)-N′-cyano-N″-4-pyridylguanidine),sesquiterpene lactones such as parthenoilde, helenalin, miller-9E-enolidand budlein A.

Especially preferred proteasome and protease inhibitors according to thepresent invention are, for example peptide aldehydes: ALLnL(N-acetyl-leucinyl-leucinyl-norleucynal, MG101), LLM(N-acetyl-leucinyl-leucinyll-methional), Z-LLnV(carbobenzoxyl-leucinyl-leucinyl-norvalinal, MG115), Z-LLL(carbobenzoxyl-leucinyl-leucinyl-leucynal, MG132), Z-LLL-B(OH)₂(MG-262), boronic acid derivatives, e.g. PS-273, PS-293, PS-296, PS-303,PS-305, PS-313, PS-321, PS-325, PS-334, PS-341, PS-364, PS-352, PS-383,lactacystine, beta-lactone, boronic acid peptide, ubiquitin ligaseinhibitors deoxyspergualin, APNE(N-acetyl-DL-phenylalanine-beta-naphthylester), BTEE (N-benzoylL-tyrosine-ethylester), DCIC (3,4-dichloroisocoumarin), DFP(diisopropyl-uorophosphate), TPCK (N-alpha-tosyl-L-phenylalaninechloromethyl ketone), TLCK (N-alpha-tosyl-L-lysine chloromethyl ketone),FK506 (Tacrolimus), Cyclosporin A.

Especially preferred apoptosis modulators according to the presentinvention are, for example farnesyl transferase inhibitors, e.g.R115777, SCH66336, BMS214662, Imatinib, 17-AAG, EGFR inhibitors, e.g.,ZD1839, MEK inhibitors, e.g., PD 032590, RAF inhibitors e.g.,BAY43-9006, erlotinib, PKC inhibitors, e.g. UCN-01, PKC-412, Bryostatin,ISIS-3521, LY333531, safingol, CGP-41251 (midostaurin), HDAC inhibitors,e.g., suberoyl-3-aminopyridineamide hydroxamic acid, lonidamine,apoptin, survivin, rapamycin, CCI-779, RAD001 (everolimus), PXD101,tyrosine kinase inhibitors, e.g. Iressa, OSI-774, STI-571, inhibitors ofenzymes in the mitogen-activated protein kinase pathway e.g., PD-098059,U-0126.

Especially preferred cell cycle modulators according to the presentinvention are, for example flavopiridol, bryostain-1, roscovitine,BMS-387032, perifosine, or lovastatin.

Especially preferred enzyme inhibitors according to the presentinvention are, for example inhibitors of gamma-glutamyl cystinesynthetase e.g., buthione, sulfoxime.

Especially preferred angiogenesis inhibitors according to the presentinvention are, for example thalidomide, endostatin, celecoxib, ABT-510,combrestatin A4, dalteparin, dimethylxanthenone acetic acid,lenalidomide, LY317615 (enzastaurin), PPI-2458, ADH-1 (exherin),AG-013736, AMG-706, AZD2171, Bay 43-9006 (sorafenib), BMS-582664,CHIR-265, GW786034 (pazopanib), PI-88, PTK787/ZK 222584 (vatalanib),RAD001 (everolimus), SU11248 (sunitinib), suramin, XL184, ZD6474,ATN-161, or EMD 121974 (cilenigtide).

Especially preferred hormones or hormone derivatives according to thepresent invention are, for example aminogluthemid, buserilin,cyproteronacetate, droloxifen, ethinylestradiol, flutamid, formesta,fosfestrol, gestonoroncaproate, goserilin, leuprolein, lynestrenol,medrogeston, medroxyprogesteronacetate, megestrolactetate, octreotid,tamoxifen, toremifin, triptorelin, anastrazole, exemestane, orletrozone.

For preparing the protein-binding prodrugs of the present invention thefirst and second pharmaceutically and/or diagnostically active compoundsare bound to a bifunctional protein-binding linker through anacid-sensitive and/or hydrolytically and/or enzymatically cleavablebond. This derivatisation is carried out with a suitable functionalgroup of the first and second pharmaceutically and/or diagnosticallyactive compound which is a HO—, NH₂—, HOOC—, HO₃S—, or carbonyl group.If the first and second pharmaceutically and/or diagnostically activecompound does not contain a suitable functional group, then this isintroduced through chemical modification; i.e. the above-mentioned firstand second pharmaceutically and/or diagnostically active compoundsadditionally include all derivatives that possess a HO—, NH₂—, HOOC—,HO₃S—, and/or carbonyl group.

In the prodrugs of the present invention the two or more cleavablelinkers of the above-defined prodrug can independently be cleavedhydrolytically and/or enzymatically and/or pH-dependently. According tothe present invention, each of the cleavable linkers in theabove-defined prodrug may be the same or different. The cleavable linkerof the first and of the second pharmaceutically and/or diagnosticallyactive compound may for example both be acid-sensitive or enzymaticallycleavable, or according to a further example, the cleavable linker ofthe first pharmaceutically and/or diagnostically active compound my bean acid-labile linker, while the cleavable linker of the secondpharmaceutically and/or diagnostically active compound may be a linkercleavable by an enzyme.

In a preferred embodiment of the present invention, the firstpharmaceutically and/or diagnostically active compound of the prodrug asdefined above is a cytostatic agent selected from the group consistingof N-nitrosoureas such as nimustine, the anthracyclines doxorubicin,daunorubicin, epirubicin, idarubicin, mitoxantrone and ametantrone, andany derivatives thereof; the alkylating agents chlorambucil,bendamustine, melphalan, and oxazaphosphorines, and any derivativesthereof; the antimetabolites, for example purine antagonists orpyrimidin antagonists, such as 5-fluorouracil, 2′-deoxy-5-fluorouridine,cytarabine, cladribine, fludarabine, pentostatine, gemcitabine andthioguanine, and any derivatives thereof; folic acid antagonists such asmethotrexate, raltitrexed, pemetrexed or plevitrexed, the taxanespaclitaxel and docetaxel, and any derivatives thereof; the camptothecinstopotecan, irinotecan, 9-aminocamptothecin and camptothecin, and anyderivatives thereof; the Vinca alkaloids vinblastine, vincristine,vindesine and vinorelbine, and any derivatives thereof, calicheamicinsand any derivatives thereof, maytansinoids and any derivatives thereof,auristatins and any derivatives thereof, epothilones and any derivativesthereof, bleomycin, dactinomycin, plicamycin, mitomycin C andcis-configured platinum(II) complexes.

According to another embodiment of the present invention, the secondpharmaceutically and/or diagnostically active compound of the prodrug asdefined above is a cytostatic agent selected from the group consistingof N-nitrosoureas such as nimustine, the anthracyclines doxorubicin,daunorubicin, epirubicin, idarubicin, mitoxantrone and ametantrone, andany derivatives thereof; the alkylating agents chlorambucil,bendamustine, melphalan, and oxazaphosphorines, and any derivativesthereof; the antimetabolites, for example purine antagonists orpyrimidin antagonists, such as 5-fluorouracil, 2′-deoxy-5-fluorouridine,cytarabine, cladribine, fludarabine, pentostatine, gemcitabine andthioguanine, and any derivatives thereof; folic acid antagonists such asmethotrexate, raltitrexed, pemetrexed and plevitrexed, the taxanespaclitaxel and docetaxel, and any derivatives thereof; the camptothecinstopotecan, irinotecan, 9-aminocamptothecin and camptothecin, and anyderivatives thereof; the Vinca alkaloids vinblastine, vincristine,vindesine and vinorelbine, and any derivatives thereof; calicheamicinsand any derivatives thereof; maytansinoids and any derivatives thereof;auristatins and any derivatives thereof; epothilones and any derivativesthereof, bleomycin, dactinomycin, plicamycin, mitomycin C andcis-configured platinum(II) complexes.

The combination of cytostatic agents is not restricted in any way.Preferred combinations are those that include cytostatic agents thatexhibit different modes of action or act synergistically, such asdoxorubicin and paclitaxel.

According to another embodiment of the present invention, the secondpharmaceutically and/or diagnostically active compound of theabove-defined prodrug is a multidrug resistance (MDR) modulator selectedfrom a first generation MDR modulator, a second generation MDRmodulator, or a third generation MDR modulator.

According to a specific embodiment of prodrug as defined above, themultidrug resistance (MDR) modulator of the first generation is selectedfrom the group consisting of verapamil, dihydropyridins, cyclosporin Aand D, tacrolismus, rapamyin, digoxin, digitoxin, quinidin, or anyderivative thereof.

According to another specific embodiment of present invention themultidrug resistance (MDR) modulator of the second generation usable inthe prodrug as defined above is selected from the group consisting oflovastatin, atorvastin, analogues of reserpine, trifluoroperazine,pervilleines A-F, valspodar, dexverapamil, biricodar, bepridil,erythromycin, levofloxacin, losartan, morphin, rifampin, phenytoin,colchicin, rhodamin 123, amprenavir, indinavir, nelfinavir, saqunavir,ritonavir, or any derivative thereof.

In another specific embodiment, the multidrug resistance (MDR) modulatorusable in the above-defined prodrug of the third generation is selectedfrom the group consisting of XR9576, LY335979, OC-144-093, R101933,GF120918, ONT-093, MS-209, S-9788, reversin 205 and 121, or any relatedderivative.

In another preferred embodiment of the present invention, the secondpharmaceutically and/or diagnostically active compound of the prodrug asdefined above is a transcription factor inhibitor modulating NF-κB,comprising compounds capable of inhibiting activation of NF-κB,I-κB-alpha phosphorylation and/or degradation inhibitors, miscellaneousinhibitors of NF-κB as well as proteasome inhibitors.

In another preferred embodiment of the present invention, the secondpharmaceutically and/or diagnostically active compound of the prodrug asdefined above is a transcription factor inhibitor selected from thegroup consisting of sesquiterpene lactones.

In a specific embodiment of the above-defined prodrug according to thepresent invention, the protein-binding moiety is selected from the groupconsisting of a maleinimide group, a halogenacetamide group, ahalogenacetate group, a pyrildylthio group, a vinylcarbonyl group, anaziridin group, a disulfide group, an substituted or unsubstitutedacetylene group, or an N-hydroxysuccininide ester group.

According to another embodiment of the present invention, at least oneof the first or second pharmaceutically and/or diagnostically activecompounds of the prodrug as defined above contains one or moreradionuclides, one or more positron emitters, one or more NMR contrastagents, one or more fluorescent compound(s), or one or morenear-infrared contrast agents.

According to one specific embodiment, the prodrug as defined abovecomprises

(i) a cytostatic agent as the first pharmaceutically and/ordiagnostically active compound,

(ii) a MDR modulator as the second pharmaceutically and/ordiagnostically active compound,

(iii) at least two cleavable linkers, and

(iv) a protein-binding moiety,

wherein the cytostatic and the MDR modulator are each bound to acleavable linker.

In a specific example of the prodrug as defined above, the cytostatic isdoxorubicin, paclitaxel or a camptothecin derivative, the MDR modulatoris a p-glycoprotein modulator and the protein-binding moiety is amaleimide derivative.

According to a preferred embodiment of the prodrug as defined above, thecytostatic is camptothecin or a derivative thereof, the MDR modulator isOC144093 and the protein-binding moiety is a maleimide derivative.

According to another specific embodiment of the present invention, theabove-defined prodrug comprises

(i) a cytostatic as the first pharmaceutically and/or diagnosticallyactive compound,

(ii) a transcription factor inhibitor as the second pharmaceuticallyand/or diagnostically active compound,

(iii) at least two cleavable linkers, and

(iv) a protein-binding moiety,

wherein the cytostatic and the transcription factor inhibitor are eachbound to a cleavable linker.

In one specific embodiment of the above-defined prodrug, the cytostaticis doxorubicin, paclitaxel, gemcitabin or a camptothecin derivative, thetranscription factor inhibitor is a sesquiterpene lactone derivative andthe protein-binding group is a maleimide derivative.

According to a preferred embodiment of the prodrug as defined above, thecytostatic is doxorubicin, paclitaxel, gemcitabin or a camptothecin orany derivative thereof, the transcription factor inhibitor is helenalin,budlein A or miller-9E-enolid, or any derivative thereof, and theprotein-binding moiety is a maleimide derivative.

Another aspect of the present invention relates to a pharmaceuticalcomposition, comprising the prodrug as defined above, and optionally apharmaceutically acceptable carrier and/or a pharmaceutically acceptableadjuvent and/or a diluent.

The pharmaceutical composition may for example contain solvents anddiluents such as sodium chloride solution or a solution containing anypharmaceutically acceptable buffer. Moreover, the pharmaceuticalcomposition of the present invention may be in any form suitable foradministration to a patient, for example in an injectable form, as atablet or a capsule, or as a composition for inhalation.

According to a specific embodiment, the above-defined pharmaceuticalcomposition is for treatment of a disease selected from the groupconsisting of cancer, autoimmune diseases, acute or chronic inflammatorydiseases or diseases caused by viruses and/or microorganisms.

According to a further specific embodiment, the above-definedpharmaceutical composition is for treatment of cancer.

Another aspect of the present invention relates to the use of theprodrug as defined above in the manufacturing of a pharmaceuticalcomposition for treating or diagnosing a patient suffering from adisease selected from the group consisting of cancer, autoimmunediseases, acute or chronic inflammatory diseases or diseases caused byviruses and/or microorganisms.

According to another embodiment of the present invention, the prodrug asdefined above may be comprised in a kit, which may further contain oneor more adjuvants, such as a buffer or a pharmaceutically acceptablecarrier.

The figure shows:

FIG. 1 shows the structure of a dual acting prodrug comprising theP-glycoprotein inhibitor OC144093 and camptothecin.

FIG. 2 shows the structure of a dual acting prodrug comprising an aminoderivative of the proteasom inhibitor MG-132(aminobenzoylamide-Leu-Leu-Leu-CHO) and the anticancer agent paclitaxel:

FIG. 3 shows the structure of a dual acting prodrug comprising the twoanticancer agents paclitaxel and doxorubicin (12)

FIGS. 4 a and 4 b show the synthetic route for obtaining a dual actingprodrug comprising the two anticancer agents paclitaxel and doxorubicin(12)

The prodrug according to the present invention is advantageously capableof binding in situ to a thiol-containing macromolecular carrier such asendogenous albumin, thus enabling a more specific transport to thetarget tissue in a patient.

Moreover, the presence of at least two different pharmaceutically activecompounds allows to improve treatment of a disease in a patient. Inparticular, by combining two different pharmacologically activecompounds in a prodrug being able to bind in situ to a thiol-containingmacromolecule such as albumin, it is surprisingly achieved toefficiently accumulate both drugs in the target tissue of the patientand, after cleavage of the active agents, to advantageously reduce atleast one of the biochemical mechanisms known to reduce the efficacy ofone or more of the active agents employed.

The present invention is illustrated in the following example withoutany limitation thereto.

EXAMPLES Example 1

According to the present invention, a dual acting prodrug is preparedcomprising the P-glycoprotein inhibitor OC144093 and camptothecin.

In this example, camptothecin and OC144093 are bound to a bifunctionalmalemide derivative through a peptide spacer that is cleaved bycathepsin B or other proteases. After transport to the tumor cell theprodrugs exert their action through a dual acting principle: OC144093inhibits the efflux pump P-glycoprotein that is responsible formultidrug resistance thus preventing the efflux of campthothecin andallowing this drug to exert its antitumor efficacy in the tumor cell.

Example 2

According to the present invention, a dual acting prodrug is comprisesan amino derivative of the proteasom inhibitor MG-132(aminobenzoylamide-Leu-Leu-Leu-CHO) and the anticancer agent paclitaxel:

In this example, paclitaxel and the proteasom inhibitoraminobenzoylamide-Leu-Leu-Leu-CHO are bound to a bifunctional malemidederivative through a peptide spacer that is cleaved by cathepsin B orother proteases.

Example 3

According to the present invention, a dual acting prodrug 12 is preparedcomprising the two anticancer agents paclitaxel and doxorubicin (seeFIG. 3). The pharmaceutically active compounds, i.e. doxorubicin andpaclitaxel, are released from the prodrug by cleavage of an acid-labilehydrazone linker and a cathepsin B cleavable dipeptide linker. Theprodrug according to the present invention is advantageously capable ofbinding in situ to a thiol-containing macromolecular carrier such asalbumin, thus enabling a more specific transport to the tumor tissue andreleasing both doxorubicin and paclitaxel in tumor tissue and tumorcells. In a 72 cytotoxicity assay against HT29 colon carcinoma cellsprodrug 12 showed an IC₅₀ value in the low nanomolar region (IC₅₀˜11nM).

The prodrug 12 was synthesized according to FIGS. 4 a and 4 b asdescribed below.

Synthesis of EMC-Glu(NHNH-Mtt)-OH (5): DMAP (0.1 equiv, 14.8 mmol, 1.81g) and DIPC (1.5 equiv, 222.3 mmol, 34.5 mL) were added under nitrogenatmosphere slowly at 0° C. to a solution of Cbz-Glu-OtBu (148.2 mmol, 50g) and tert.-butyl carbazate (1.5 equiv, 222.3 mmol, 29.4 g) in dry DCM(100 mL). The mixture was stirred at RT for 16 h. The solid was removedby suction filtration and washed with DCM. The organic layer wasextracted with 0.1 M HCl (10×100 mL). The organic phase was thenextracted with brine, water, dried and the solvent was removed underreduced pressure to give 1 as a white solid (66.6 g). C₂₂H₃₃N₃O₇, ExactMass: 451.23, MS (ESI): m/e 474.0 (M+Na)⁺. 1 (60 g) was dissolved undernitrogen in dry methanol (200 mL). Pd/C (10%, 2.5 g) was added and ahydrogen balloon was applied to the flask. The reaction mixture wasstirred at RT for 4 d during which the balloons were exchanged with newones. The solution was then diluted with methanol, filtered over celiteand the solvent was removed under reduced pressure. The oily rest waspurified by flash chromatography on silica with CHCl₃/MeOH 20:1 to give2 as a white solid (42 g, 50%). C₁₄H₂₇N₃O₅, Exact Mass: 317.2, MS (ESI):m/e 318.0 (M+H)⁺, m/e 340.0 (M+Na)⁺. The 6-maleimidocaproic acidchloride was prepared from maleimidocaproic acid (82.78 mmol, 17.35 g)and oxalic acid chloride (1.0 equiv, 82.78 mmol, 9.93 mL) in dry DCM(180 mL). Dry triethylamine (82.78 mmol, 11.47 mL) was added at RT undernitrogen atmosphere to a solution of 2 (82.78 mmol, 26.36 g) in dry DCM(300 mL) followed by slow addition of the solution of 6-maleimidocaproicacid chloride. The reaction solution was stirred at RT for 18 h. Thesolvent was removed under reduced pressure. The oily residue waspurified by flash chromatography on silica eluting with EE/hexane (i)1:1, (i) 2:1, (i) 4:1 to give 3 as a white solid (36 g, 76%).C₂₄H₃₈N₄O₈, Exact Mass: 510.27, (ESI): m/e 533.1 (M+H)⁺. A solution of 3(32.4 g) and TFA (165 mL) in CH₂Cl₂ (165 mL) was stirred at RT for 80min. The product was precipitated with diethyl ether (4 L) as aTFA-salt. 4 was then collected by suction filtration, washed with etherand dried (20 g, 68%). C₁₅H₂₂N₄O₆, Exact Mass: 354.15, (ESI): m/e 355.1(M+H)⁺. A stirred suspension of 4 (11 mmol, 5 g,) in dry DCM (50 mL)under nitrogen atmosphere at RT was treated with trimethylsilyl chloride(2.1 equiv, 23.1 mmol, 3 mL) and DIEA (1.05 equiv, 11.55 mmol, 1.9 mL).The mixture was heated at reflux for 1 h, and then cooled to 0° C. DIEA(3.1 equiv, 63.8 mmol, 5.8 mL) was added, followed by 4-metyltritylchloride (1.05 equiv, 11.55 mmol, 3.41 g). The reaction was stirred atRT for 16 h. Methanol (50 mL) was added and the solution was stirred for5 min. The solvent was evaporated at 30° C., and the residue waspartitioned between DCM and pH 5 buffer (acetate). The organic phase waswashed with pH 5 buffer, water, and brine, dried and the solvent wasevaporated. The oily residue was purified by flash chromatography onsilica eluting with CHCl₃/CH₃OH (10:1) to give 5 as pale yellow foam(4.5 g, 83%). C₃₅H₃₈N₄O₆, Exact Mass: 610.28, (ESI): m/e 633.1 (M+Na)⁺.¹³C NMR (100.61 MHz, CDCl₃): δ=21 (−, CH₃), 25, 26, 28, 37, 39, 41, 44(−, 7×CH₂), 55 (+, CONHCH), 72 (+, Ar₃ C), 135 (+, CHCH), 127, 128, 129,130 (−, Ar), 138, 141, 144 (−, Ar), 170, 171, 174 (−, HOCO, 4×NCO). Astirred solution of 5 (6.22 mmol, 3.8 g) and HOSu (1.05 equiv, 6.60mmol, 755 mg) in dry THF (25 mL) at 0° C. was treated with DCC (1.05equiv, 6.60 mmol, 1.36 g). After 20 min, the mixture was allowed to warmto RT and was stirred for 16 h. The solid by-product was filtered off,washed with dry THF, and the solvent was evaporated. The residue waspurified by flash chromatography on diol, eluting with THF/hexane (1:1)to furnish 6 as a white solid (2.70 g, 62%). C₃₉H₄₁N₅O₈, Exact Mass:707.30, (ESI): m/e 730.2 (M+Na)⁺.

Synthesis of EMC-Glu(NH-NHMtt)-Phe-Lys(MMT)-PABC-PNP (9): A stirredsolution of 7 (1.11 mmol, 0.73 g) and 6 (1.2 equiv, 1.33 mmol, 0.95 g)in dry THF (20 mL) was treated at RT with dry Et₃N (1.0 equiv, 1.11mmol, 155 μL). The mixture was allowed to stir at RT for 20 h and thenthe solvent was evaporated, and the residue was purified by flashchromatography on silica gel eluting with CHCl₃/CH₃OH (15:1)+2% Et₃N togive 8 as a white solid (0.93 g, 75%). C₇₇H₈₂N₈O₈, Exact Mass: 1246.63,(ESI): m/e 1247.4 (M+H)⁺. 8 (0.2 mmol, 255 mg) and bis-PNP carbonate (5equiv, 1 mmol, 348 mg) were dissolved under nitrogen atmosphere at RT indry DCM (15 mL) and treated with DIEA (3 equiv, 0.6 mmol, 102 μL). Thereaction mixture was stirred for 3 d. The solvent was removed and theresidue was purified by flash chromatography on diol eluting withTHF/hexane (3:2) to give 9 as a pale yellow solid (150 mg, 52%).C₈₄H₈₅N₉O₁₂, Exact Mass: 1411.63, (ESI): m/e 1412.2 (M+H)⁺.

Synthesis of 12: DMAP (417 mg) was added to a solution of 9 (550 mg) andpaclitaxel (332 mg) in dry DCM (20 mL). The solution was stirred at RTfor 20 h. The product was precipitated from ether and then purified byflash chromatography on silica eluting with CHCl₃/MeOH 20:1 to give 10as a solid (200 mg, 67%). A solution of 10 (180 mg) in 1% TFA in DCM (2mL) was stirred at RT for 1 h. The product 11 was precipitated fromether as a white solid (100 mg, 66%). C₈₅H₉₉N₉O₂₃, Exact Mass: 1613.69,(ESI): m/e 1636.3 (M+Na)⁺11 (5 equiv, 20 mg) and doxorubicin HCl (1equiv, 1.2 mg) were dissolved in dry methanol (1 mL) and the reactionsolution was stirred at RT for 18 h. The product was precipitated fromisopropanol/ether and then purified by HPLC (25 cm Synergi 4 u Max-RP 80A (Phenomenex), flow rate: 1 mL/min, mobile phase A: pH 7/AcN 80:20,mobile phase B: pH7/AcN 40:60, retention time: 29.63 min) to yield 3 mg12. C₁₁₄H₁₂₇ClF₃N₁₀O₃₅, Exact Mass: 2138.85, (ESI): m/e 2140.0 (M+H)⁺.

1. A prodrug comprising (i) at least a first pharmaceutically and/ordiagnostically active compound, (ii) at least a second pharmaceuticallyand/or diagnostically active compound, (iii) two or more cleavablelinkers, and (iv) a protein-binding moiety, wherein the first and thesecond pharmaceutically and/or diagnostically active compounds are eachbound to a cleavable linker, and wherein the first and the secondpharmaceutically and/or diagnostically active compounds are differentfrom each other.
 2. The prodrug according to claim 1, wherein the firstand second pharmaceutically and/or diagnostically active compounds areindependently selected from the group consisting of a cytostatic agent,a cytokine, an immunosuppressant, an antirheumatic, an antiphlogistic,an antibiotic, an analgesic, a virostatic, or an antimycotic agent, atranscription factor inhibitor, a cell cycle modulator, a MDR modulator,a proteasome or protease inhibitor, an apoptosis modulator, an enzymeinhibitor, an angiogenesis inhibitor, a hormone or hormone derivative, aradioactive substance, a light emitting substance, or a light absorbingsubstance.
 3. The prodrug according to claim 1, wherein the firstpharmaceutically and/or diagnostically active compound is a cytostaticagent selected from the group consisting of N-nitrosoureas, theanthracyclines doxorubicin, daunorubicin, epirubicin, idarubicin,mitoxantrone and ametantrone, and any derivatives thereof; thealkylating agents chlorambucil, bendamustine, melphalan, andoxazaphosphorines, and any derivatives thereof; the antimetabolites5-fluorouracil, 2′-deoxy-5-fluorouridine, cytarabine, cladribine,fludarabine, pentostatine, gemcitabine and thioguaninen and anyderivatives thereof; the folic acid antagonists methotrexate,raltitrexed, pemetrexed and plevitrexed,the taxanes paclitaxel anddocetaxel, and any derivatives thereof; the camptothecins topotecan,irinotecan, 9-aminocamptothecin and camptothecin, and any derivativesthereof; the Vinca alkaloids vinblastine, vincristine, vindesine andvinorelbine, and any derivatives thereof; calicheamicins and anyderivatives thereof; maytansinoids and any derivatives thereof;auristatins and any derivatives thereof; epothilones and any derivativesthereof bleomycin, dactinomycin, plicamycin, mitomycin C andcis-configured platinum(II) complexes.
 4. The prodrug according to claim3, wherein the second pharmaceutically and/or diagnostically activecompound is a cytostatic agent selected from the group consisting ofN-nitrosoureas, the anthracyclines doxorubicin, daunorubicin,epirubicin, idarubicin, mitoxantrone and ametantrone, and anyderivatives thereof; the alkylating agents chlorambucil, bendamustine,melphalan, and oxazaphosphorines, and any derivatives thereof; theantimetabolites 5-fluorouracil, 2′-deoxy-5-fluorouridine, cytarabine,cladribine, fludarabine, pentostatine, gemcitabine and thioguanine, andany derivatives thereof; the folic acid antagonists methotrexate,raltitrexed, pemetrexed and plevitrexed, the taxanes paclitaxel anddocetaxel, and any derivatives thereof; the camptothecins topotecan,irinotecan, 9-aminocamptothecin and camptothecin, and any derivativesthereof; the Vinca alkaloids vinblastine, vincristine, vindesine andvinorelbine, and any derivatives thereof; calicheamicins and anyderivatives thereof; maytansinoids and any derivatives thereof;auristatins and any derivatives thereof; epothilones and any derivativesthereof; bleomycin, dactinomycin, plicamycin, mitomycin C andcis-configured platinum(II) complexes.
 5. The prodrug according to claim1, wherein the second pharmaceutically and/or diagnostically activecompound is a multidrug resistance (MDR) modulator selected from a firstgeneration MDR modulator, a second generation MDR modulator, or a thirdgeneration MDR modulator.
 6. The prodrug according to claim 5, whereinthe multidrug resistance (MDR) modulator of the first generation isselected from the group consisting of verapamil, dihydropyridins,cyclosporin A and D, tacrolismus, rapamyin, digoxin, digitoxin,quinidin, or any derivative thereof.
 7. The prodrug according to claim5, wherein the multidrug resistance (MDR) modulator of the secondgeneration is selected from the group consisting of lovastatin,atorvastin, analogues of reserpine, trifluoroperazine, pervilleines A-F,valspodar, dexverapamil, biricodar, bepridil, erythromycin,levofloxacin, losartan, morphin, rifampin, phenytoin, colchicin,rhodamin 123, amprenavir, indinavir, nelfinavir, saqunavir, ritonavir orany derivative thereof.
 8. The prodrug according to claim 5, wherein themultidrug resistance (MDR) modulator of the third generation is selectedfrom the group consisting of XR9576, LY335979, OC-144093, R101933,GF120918, ONT-093, MS-209, S-9788, reversin 205 and 121, or any relatedderivative.
 9. The prodrug according to claim 1, wherein the secondpharmaceutically and/or diagnostically active compound is atranscription factor inhibitor modulating NF-κB, comprising compoundscapable of inhibiting activation of NF-κB, I-κB-alpha phosphorylationand/or degradation inhibitors, miscellaneous inhibitors of NF-κKB aswell as proteasome inhibitors.
 10. The prodrug according to claim 1,wherein the second pharmaceutically and/or diagnostically activecompound is a transcription factor inhibtor selected from the groupconsisting of sesquiterpene lactones.
 11. The prodrug according to claim1, wherein the protein-binding moiety binds to a serum protein, anantibody or antibody fragments, a synthetic polymer, a peptide, a growthfactor, a polysaccharide, or a sugar.
 12. The prodrug according to claim1, wherein the protein-binding moiety binds in situ to cysteine-34 ofalbumin.
 13. The prodrug according to claim 1, wherein theprotein-binding moiety is selected from the group consisting of amaleinimide group, a halogenacetamide group, a halogenacetate group, apyrildylthio group, a vinylcarbonyl group, an aziridin group, adisulfide group, a substituted or unsubstituted acetylene group, or anN-hydroxysuccininide ester group.
 14. The prodrug according to claim 1,wherein the two or more cleavable linkers can independently be cleavedhydrolytically and/or enzymatically and/or pH-dependently.
 15. Theprodrug according to claim 1, wherein at least one of the first orsecond pharmaceutically and/or diagnostically active compounds containsone or more radionuclides, one or more positron emitters, one or moreNMR contrast agents, one or more fluorescent compound(s), or one or morenear-infrared contrast agents.
 16. The prodrug according to claim 1comprising (i) a cytostatic agent as the first pharmaceutically and/ordiagnostically active compound; (ii) a MDR modulator as the secondpharmaceutically and/or diagnostically active compound; (iii) at leasttwo cleavable linkers; and (iv) a protein-binding moiety, wherein thecytostatic and the MDR modulator are each bound to a cleavable linker.17. The prodrug according to claim 16, wherein the cytostatic isdoxorubicin or a camptothecin derivative, the MDR modulator is aP-glycoprotein modulator and the protein-binding moiety is a maleimidederivative.
 18. The prodrug according to claim 1, comprising (i) acytostatic as the first pharmaceutically and/or diagnostically activecompound; (ii) a transcription factor inhibitor as the secondpharmaceutically and/or diagnostically active compound; (iii) at leasttwo cleavable linkers; and (iv) a protein-binding moiety, wherein thecytostatic and the transcription factor inhibitor are each bound to acleavable linker.
 19. The prodrug according to claim 18, wherein thecytostatic is doxorubicin, paclitaxel, gemcitabin or a camptothecinderivative, the transcription factor inhibitor is a sesquiterpenelactone derivative and the protein-binding moiety is a maleimidederivative.
 20. The prodrug according to claim 18, wherein thecytostatic is doxorubicin, paclitaxel, gemcitabin or a camptothecinderivative, the transcription factor inhibitor is helenalin,miller-9E-enolid or budlein A and the protein-binding moiety is amaleimide derivative.
 21. A pharmaceutical composition comprising theprodrug according to claim 1, and optionally a pharmaceuticallyacceptable carrier and/or a pharmaceutically acceptable adjuvent and/ora diluent.
 22. The pharmaceutical composition according to claim 21 forthe treatment of a disease selected from the group consisting of cancer,autoimmune diseases, acute or chronic inflammatory diseases or diseasescaused by viruses and/or microorganisms.
 23. A method for treating ordiagnosing a patient suffering from a disease selected from the groupconsisting of cancer, autoimmune diseases, acute or chronic inflammatorydiseases or diseases caused by viruses and/or microorganisms, saidmethod comprising administering to the patient the prodrug of claim 1.